case 43

65year old female
DOA -24/08/2024
DOD -29/08/2024
CKD DURATION -not known and is on maintenance hemodialysis since 8months


Diagnosis
CHRONIC RENAL FAILURE AND DIABETIC NEPHROPATHY K/C/O HTN AND TYPE 2 DM SINCE 10 YRS 

CHIEF COMPLAINTS
C/O PEDAL EDEMA SINCE 15 DAYS.

 HOPI-PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS AGO AND THEN HE DEVELOPED 15 DAYS AGO.
 B/L PEDAL EDEMA,WHICH IS EXTENDING UPTO KNEE, GRADE 2, PITTING TYPE H/O FEVER SINCE 2 DAYS, LOW GRADE AND INTERMITTENT TYPE NO DECREASED URINE OUTPUT N/H/O COLD, COUGH, ALLERGIES
N/H/O CHEST PAIN, PALPITATIONS, SWEATING,SOB N/H/O BURNING MICTURITION AND CONSTIPATION N/H/O ABDOMINAL PAIN, NAUSEA, VOMITING, LOOSE STOOLS .


PAST HISTORY
K/C/O HTN SINCE 10 YRS
 K/C/O DM 2 SINCE 10YRS
N/K/C/O TB, EPILEPSY, ASTHMA, CVA, CAD GENERAL EXAMIANTION
NO PALLOR,ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY BP- 140/60 MM HG PR- 90 BPM
TEMP- AFEBRILE
RR-16CPM
SPO2- 99%
SYSTEMIC EXAMINAYION
CVS- S1 , S2 + AND NO MURMURS
RS- BAE+, NVBS
CNS- NFND
PER ABDOMEN - SOFT, NON TENDER

INVESTIGATION 

HB -7.2
MCV -72.8
MCH -26.5
MCHC -36.4
TLC -11000
PLT -2.52

S.iron -49
S.ferritin -245.6

RFT
UREA102 mg/dl
CREATININE6.3 mg/dl
URIC ACID5.1 mmol/L
CALCIUM8.5mg/dl
PHOSPHOROUS4.3 mg/dl
SODIUM140 mmol/L
POTASSIUM3.9 mmol/L
CHLORIDE104mmol/L

CUE 
ALBUMIN++
SUGAR+

LFT
Total Bilurubin0.48 mg/dl
DirectBilurubin0.17 mg/dl
SGOT(AST)10 IU/L
SGPT(ALT)10 IU/L
ALKALINE PHOSPHATAS 261
TOTALPROTEINS6.1 gm/dl
ALBUMIN3.25 gm/dl
A/G RATIO 1.14

2D ECHO 
EF -51%
Global hypokinesa 

SMEAR -microcytic hypochromic 

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -1
ADMISSION IN ICU -0

Treatment Given(Enter only Generic Name)
INJ. HAI SC TID ACCORDING TO GRBS
SALT RESTRICTION 2 GM/ DAY FLUID RESTRICTION <1.5 LIT/DAY
 T. NODOSIS 500MG PO/BD 
TAB. LASIX 40 MG PO/BD 
T. SHELCAL XT PO/OD 2PM 
T. OROFOR X T PO/OD 2PM
 T. NICARDIA 20MG PO/BD
 T. MET XL 12.5 MG PO/OD
INJ.EPO 4000 U SC WEELY ONCE
INJ IRON SUCROSE 1AMP IN 100ML NV IVO OD

Advice at Discharge

FLUID RESTRICTION[<1.5 LIT/DAY] SALT RESTRICTION[<2GM/DAY]
 INJ. HAI SC TID 4U- 4U -4U
GLUCOSE MONITERING AT HOME WITH GLUCOMETER
 INJ. NODOSIS 500MG PO/BD
 TAB. LASIX 40 MG PO/BD
 T. SHELCAL XT PO/OD 2PM
 T. OROFOR X T PO/OD 2PM
 T. NICARDIA 20MG PO/BD
 T. MET XL 12.5 MG PO/OD
INJ.EPO 4000 U SC WEELY ONCE
INJ IRON SUCROSE 1AMP IN 100ML NV IVO OD


Follow up at 3months -patient has lost to follow-up .

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